MAY 7, 2020
PROGRESSIVE
OPINION AND NEWS
DOWN WITH
SCIENCE! SEE ALSO THE NYT UPDATES ON STATISTICS AFTER THE RIFT BETWEEN CDC AND
THE WHITE HOUSE. WILL THEY HAVE THE POWER TO BACK UP THEIR PROFESSIONAL OUTPUT
AGAINST TRUMP? I CERTAINLY DO HOPE SO, BECAUSE IF THE BEST EDUCATED PEOPLE IN
OUR COUNTRY HAVE NO VOICE, THEN THE REST OF US HAVE LITTLE CHANCE, SHORT OF
STREET MARCHES AND DEMONSTRATIONS. SEE: https://www.nytimes.com/2020/05/07/us/coronavirus-updates-cases-deaths.html
White House
Blocks C.D.C. Guidance Over Economic and Religious Concerns
Detailed
guidelines for reopening drafted by the Centers for Disease Control and
Prevention were blocked from publication after Trump administration
officials labeled them “overly prescriptive.”
By Abby
Goodnough and Maggie Haberman
May 7, 2020
Updated 6:23
p.m. ET
PHOTOGRAPH --
Restaurants recently began to reopen in San Antonio. To date, 24 states have
begun allowing certain businesses to reopen, sometimes only in certain
counties.Credit...Christopher Lee for The New York Times
Abby
GoodnoughMaggie Haberman
WASHINGTON — As
President Trump rushes to reopen the economy, a battle has erupted
between the White House and the Centers for Disease Control and Prevention over
the agency’s detailed guidelines to help schools, restaurants, churches and
other establishments safely reopen.
A copy of the C.D.C.
guidance* obtained by The New York Times includes sections for child care
programs, schools and day camps, churches and other “communities of faith,”
employers with vulnerable workers, restaurants and bars, and mass transit
administrators. The recommendations include using disposable dishes and
utensils at restaurants, closing every other row of seats in buses and subways
while restricting transit routes among areas experiencing different levels of
coronavirus infection, and separating children at school and camps into
groups that should not mix throughout the day.
But White House
and other administration officials rejected the recommendations over
concerns that they were overly prescriptive, infringed on religious rights and
risked further damaging an economy that Mr. Trump was banking on to recover
quickly. One senior official at the Department of Health and Human Services
with deep ties to religious conservatives objected to any controls on
church services.
“Governments
have a duty to instruct the public on how to stay safe during this crisis
and can absolutely do so without dictating to people how they should worship
God,” said Roger Severino, the director of the Department of Health and
Human Services’ Office for Civil Rights, who once oversaw the DeVos Center for
Religion and Civil Society at the Heritage Foundation.
A spokesman for
the C.D.C. said the guidance was still under discussion with the White House and
a revised version could be published soon.
“Over the last
week, C.D.C. has been working on additional recommendations and guidance for
reopening communities, returning to public events, and I expect, even today,
that we’re going to receive a presentation on that,” Vice President Mike
Pence said on Thursday on a radio show broadcast in Pittsburgh. “And C.D.C.
will be doing, as they often do, is publishing health care guidance at
CDC.gov in the very near future.”
The C.D.C.’s
director, Dr. Robert R. Redfield, and other leaders of the agency have
had almost no public platform during the pandemic, with Dr. Deborah L.
Birx, an infectious diseases expert coordinating the White House’s coronavirus
response, and Dr. Anthony S. Fauci, another member of the coronavirus task
force who is the longtime director of the National Institute of Allergy and
Infectious Diseases, handling most of the public speaking on the federal
public health response, usually at briefings dominated by Mr. Trump. After
the C.D.C. recommended the public wear masks, Mr. Trump said he probably would
not do so, even as he announced the guidelines.
Latest Updates:
Coronavirus Outbreak in the U.S.
Trump’s travel
restrictions led to an exodus from hot spots — and little rigorous screening
in U.S. airports.
A drug
promoted by Trump neither helped nor harmed patients, researchers found.
A battle has
erupted between the White House and the C.D.C. over reopening
guidelines.
The rejection
of the C.D.C.’s guidelines for reopening is the latest confusing signal as the Trump
administration struggles to balance the president’s desire to quickly
reopen the country against the advice of public health experts, who have
counseled reopening methodically through a series of steps tied to reduced
rates of infection and expanded efforts to control the spread of the
coronavirus.
This week, the White
House signaled it would wind down its coronavirus task force only to reverse
course amid a public outcry. Last week, Mr. Pence refused to wear a surgical
mask at the Mayo Clinic, then apologized.
The mixed
signals extend to reopening guidelines: On April 16, Mr. Trump’s
coronavirus task force released broad guidance for states to reopen in three
phases, based on case levels and hospital capacity. But some members of the
task force and other aides saw the more detailed C.D.C. guidance as a
document that could slow down the reopening effort, according to several
people with knowledge of the deliberations inside the West Wing.
To date, 24
states, mostly in the South, Great Plains and Interior West, have begun allowing
certain businesses to reopen, sometimes only in certain counties. Many more
have businesses that are set to reopen or stay-at-home orders that could lift
in the next week or two.
In a senior
staff meeting last week at the White House, Mark Meadows, the chief of
staff, expressed concern that the guidelines were too uniform and rigid for
places with minimal numbers of cases, according to a person familiar with the
discussion.
Image -- Msgr.
Guy Massie speaking to an empty church, while streaming his service online,
on Easter in Brooklyn.Credit...Ryan Christopher Jones for The New York Times
Particularly
contentious were the C.D.C.’s recommendations for churches and other houses of
worship. Mr. Severino vocally opposed them.
“Protections
against religious discrimination aren’t suspended during an emergency,” he said
in a statement on Thursday. “This means the federal government cannot single
out religious conduct as somehow being more dangerous or worthy of scrutiny
than comparable secular behavior.”
The
recommendations for churches include encouraging all congregants to wear cloth
face coverings when inside the building, offering video streaming or drive-in
options for services and considering “suspending use of a choir or musical
ensemble” during services. It also urges churches to consider “temporarily
limiting the sharing of frequently touched objects,” like hymnals, prayer books
and passed collection baskets.
A senior Trump
administration official, who spoke on the condition of anonymity to talk freely
about internal discussions, said that Dr. Birx also expressed skepticism
about the C.D.C. guidelines in task force meetings. The official said that
Dr. Birx said she was mistrustful of the data the agency had provided,
although the official did not specify what exactly the doctor was concerned
about.
The guidance,
which the C.D.C. submitted to Dr. Birx in draft form on April 23 and to the
White House’s Office of Management and Budget last week, was to help
states, local governments and businesses adopt specific precautions to help
keep the coronavirus from spreading once they reopened. But several federal
agencies that reviewed the draft, including the Labor Department and the Office
for Civil Rights at the Department of Health and Human Services, protested,
saying it would be harmful to businesses and the economy and too burdensome
for houses of worship.
A federal
official who supports the guidance said that Dr. Birx was in favor of
publishing them, and that Joe Grogan, the director of the White House’s
Domestic Policy Council, even tried to broker a compromise — but that others in
the White House pushed back, especially on the worship section. Dr. Birx
was not available for comment.
Image -- Dr.
Deborah L. Birx this month in the Oval Office. Credit...Erin Schaff/The New
York Times
In one version
of the draft guidance, the section titled “Interim Guidance for Communities of
Faith” was left blank, with a note in capital letters referring to multiple
federal agencies that have to come to agreement. But another version included
the guidance for faith communities with the caveat that it “is not intended to
infringe on First Amendment rights as provided in the U.S. Constitution.”
“The federal
government may not prescribe standards for interactions of faith communities in
houses of worship,” the second version states. “C.D.C. offers these suggestions
that faith communities may consider and accept or reject.”
Abby Goodnough
reported from Washington, and Maggie Haberman from New York. Michael D. Shear
and Noah Weiland contributed reporting from Washington.
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Abby Goodnough
is a national health care correspondent. She has also served as bureau chief in
Miami and Boston, and covered education and politics in New York City. She joined
The Times in 1993. @abbygoodnough
Maggie Haberman
is a White House correspondent. She joined The Times in 2015 as a campaign
correspondent and was part of a team that won a Pulitzer Prize in 2018 for
reporting on President Trump’s advisers and their connections to Russia.
@maggieNYT
THE NEW YORK
TIMES HAS A GOOD SERIES ON CORONAVIRUS SUBJECTS TODAY. SOME, LIKE THE WAY
FOR-PROFIT NURSING HOMES ARE RUN, ARE SIMPLY NAUSEATING. OTHERS OFFER A LITTLE
HOPE.
LIVE UPDATES
Updated May 7,
2020, 7:59 p.m. ET20 minutes ago
Coronavirus
Live Updates:
Travel
Restrictions Led to Exodus From Hot Spots, but Few Rigorous
Screenings
The White House
blocked the C.D.C. over reopening guidelines. Another 3.2 million people
filed for unemployment benefits. A new study found that nearly everyone who
gets the disease eventually makes antibodies to the virus.
RIGHT NOW -- Gov.
Gretchen Whitmer of Michigan said she would allow manufacturing workers —
including those at major auto companies — to return to work beginning Monday.
. . . .
A new study
finds that nearly everyone who gets the disease eventually makes antibodies to
the virus
VIDEO -- A new
study finds that nearly everyone who gets the disease eventually makes
antibodies to the virus. Stanford Health
Care gave us exclusive access to show how coronavirus antibody testing works.
So we followed two caregivers and their blood, through the testing process. 6:07 DURATION.
A new study
offers a glimmer of hope in the fight against the coronavirus: Nearly everyone
who has had the disease — regardless of age, sex or severity of illness —
eventually makes antibodies.
Antibodies are immune
molecules produced by the body to fight pathogens. Typically, these
proteins confer protection against the invader.
Several
countries, including the United States, are hoping that antibody tests — flawed
though many may be — can help decide who is immune to the virus and can
return to work. People who are immune could replace vulnerable individuals,
especially in high-transmission settings, building in the population what
researchers call shield immunity.
The new study
also eased a worry that only some people — those who were severely ill, for
example — might make antibodies. In fact, the level of antibodies did not
differ by age or sex, the researchers found, and even people who had only mild
symptoms produced a healthy amount.
The new study
relied on an antibody test developed by Florian Krammer, a virologist at the
Icahn School of Medicine at Mount Sinai in New York, that has a less
than 1 percent chance of false positives.
The researchers
tested 624 people who signed up to be potential donors for convalescent plasma,
antibodies extracted from blood.
At first, tests
showed that only 511 had strong antibody levels; 42 had low levels, and 71 had
none. When 64 of those with weak or no levels came back more than a week later,
however, all but three had at least some antibodies.
That suggests
that the timing of testing for antibodies can greatly affect the results, the
researchers said.
Experts said the
next step would be to confirm that the presence of antibodies translates to
protection from the virus.
“The question
now becomes to what extent those are neutralizing antibodies, and whether that
leads to protection from infection — all of which we should presume are yes,”
said Sean Whelan, a virologist at Washington University in St. Louis.
In previous
work, Dr. Krammer’s team has found that in about a dozen people, including some
who had mild symptoms, the level of antibodies matched the level of
neutralizing activity.
So everyone who
makes antibodies is likely to have some immunity to the virus, Dr. Krammer
said. The answer to how long immunity lasts, however, will come only by
following these patients over time.
. . . .
THE LOVE OF
MONEY IS THE ROOT OF ALL EVIL.
Push for
Profits Left Nursing Homes Struggling to Provide Care
Some with private
equity owners*, focused on making money, were particularly ill equipped
and understaffed to handle Covid-19.
By Matthew
Goldstein, Jessica Silver-Greenberg and Robert Gebeloff
May 7, 2020, Updated
3:08 p.m. ET
PHOTOGRAPH -- The
Burbank Rehabilitation Center in Burbank, Ill. For-profit nursing homes score
worse in federal ratings and many are struggling to control the spread of the
coronavirus. Credit...Taylor Glascock for The New York Times
When the
pandemic struck, the majority of the nation’s nursing homes were losing
money, some were falling into disrepair, and others were struggling to attract
new occupants, leaving many of them ill equipped to protect workers and
residents as the coronavirus raged through their properties.
Their troubled
state was years in the making. Decades of ownership by private equity and
other private investment firms left many nursing homes with staggering
bills and razor-thin margins, while competition from home care attendants
and assisted-living facilities further gutted their business. Even so, many
of their owners still found creative ways to wring profits out of them,
according to an analysis of federal and state data by The New York Times.
In many cases,
investors created new companies to hold the real estate assets because the
buildings were more valuable than the businesses themselves, especially
with fewer nursing homes being built. Sometimes, investors would buy a nursing
home from an operator only to lease back the building and charge the operator
hefty management and consulting fees. Investors also pushed nursing
homes to buy ambulance transports, drugs, ventilators and other products or
services at above-market rates from other companies they owned.
These
strategies paid off handsomely for investors, but they forced nursing homes to
skimp on quality. For instance, for-profit nursing homes — roughly 70
percent of the country’s 15,400 nursing homes and often owned by private
investors — disproportionately lag behind their nonprofit counterparts
across a broad array of measures for quality, The Times found. Also, they
are cited for violations at a higher rate than nonprofit facilities.
The toll of putting
profits first started to show when the outbreak began. No nursing home
could be completely prepared for a pandemic as devastating as Covid-19, but
some for-profit homes were particularly ill equipped and understaffed, which
undercut their ability to contain the spread of the coronavirus, according
to interviews with more than a dozen nursing home workers and elder-care
lawyers.
PHOTOGRAPH -- The
Burbank Rehabilitation Center has a one-star rating — the lowest ranking in the
federal government’s five-star rating system for nursing home care.
Credit...Taylor Glascock for The New York Times
The pandemic
“has brought a lot of these issues to the forefront,” said David Grabowski,
professor of health care policy at Harvard Medical School. “With this huge
health crisis and economic downturn, we are all of a sudden seeing how risky
it is to have the ownership split between the real estate side that has the
most valuable asset and the operator, who is left with much less.”
Controlling the
real estate gives investors, including real estate investment trusts, leverage
to raise rents. Separating the real estate from the operating business
can also help limit liability in wrongful-death lawsuits, because the
latter typically has little cash and few assets.
“The
structure is designed to keep liability on the company that has the fewest
assets and the most debt,” said William Murray, a plaintiffs lawyer who
specializes in suing nursing homes.
Private equity
firms and other investors first gravitated to nursing homes more than a
decade ago, betting that aging baby boomers would create demand
irrespective of economic cycles and counting on a steady stream of Medicare
and Medicaid reimbursements.
. . . .
A recent report
on private equity buyouts of nursing homes, which studied 119 transactions from
2000 to 2017, said private equity owners tended to put “high-powered profit
maximizing incentives” first. The researchers found that after private equity
stepped in, nursing staff hours per patient fell 2.4 percent, and staff quality
as measured by federal regulators fell 3.6 percent.
“The quality of
care declines after the private equity buyout, which seems to reflect
staffing cuts,” said one of the report’s authors, Sabrina T. Howell,
assistant professor of finance at New York University’s Stern School of
Business.
Ruthie Moore, a
68-year-old certified nursing assistant who works at Burbank Rehabilitation
Center, a for-profit nursing home in Illinois owned by a prominent local
investor, said she had been overwhelmed with patients even before the pandemic.
The facility provided below-average staffing that was also highly
inconsistent, records show. On some days, there was one certified nursing
assistant for every 10 residents, according to payroll records. On other days,
there was one for every 19.
PHOTOGRAPH -- Ruthie
Moore, a certified nursing assistant who works at Burbank.
Things got much
worse when the virus hit, Ms. Moore said. Residents, including ones with
possible symptoms of Covid-19, were mixing with other patients. Personal
protective equipment was scarce, and members of the staff were told to wear the
same mask for up to two weeks, she said.
Six residents
of the Burbank facility have died of Covid-19 and 41 others have fallen sick, according to
local reports citing state health officials. The facility gets a one-star
rating — the lowest ranking in the federal government’s five-star rating
system for nursing home care. In a document filed with federal regulators for
2018, Burbank’s operator listed assets of $4.4 million and liabilities of
$10 million.
“Had we had
more staff and protective equipment, there would have been fewer deaths,” said
Ms. Moore, who recently began showing symptoms and is awaiting a diagnosis.
Burbank’s owner
is a Chicago-area investor, William Rothner. He and his family run a
network of companies that have stakes — owning a piece of either the operating
business or the building — in at least 60 nursing homes across the country,
according to disclosures and other documents. Companies owned by Mr. Rothner
also provide ventilators, pharmaceuticals, management services and payroll
services to many of those facilities, according to financial filings with
Illinois.
Most of the
nursing homes in which Mr. Rothner has an interest in Illinois reported a
net loss from operations in 2018, regulatory filings show. For instance,
the Parc at Joliet, which has had at least seven coronavirus-related deaths,
reported an operating loss of $714,000. But other companies that Mr. Rothner
owns charged the home $1.4 million in rent as well as $138,000 in professional
fees and $335,000 in fees to an affiliated pharmaceutical supply company,
among other charges, according to those filings.
Nursing Home
Ratings and Profits
The nursing
home industry was struggling financially before the coronavirus pandemic, but
facilities receiving poor ratings by federal regulators were struggling even
more.
Median Profit
by Federal Rating, 2018
[FOR CHART, GO
TO WEBSITE.]
Mr. Rothner
said in an email that there had been no “recent citations for inadequate
staffing” and “no valid assertions or claims on inadequate P.P.E.” at Burbank.
He also said his firm, Altitude Health Services, monitored management fees
taken by the separate firms that run the nursing homes to make sure they were
not excessive. He added that his firm provided ancillary services at
competitive prices that were often lower than other companies and complied with
all regulations.
Mr. Rothner’s
company also owns the buildings for two nursing homes in Sussex County,
N.J., where more than 60 residents have died of Covid-19 and where 17 of the
bodies were hidden in a small on-site morgue. His company leases the
facilities for about $8 million a year to Alliance Healthcare, which runs
the nursing homes.
On Thursday, federal
health regulators said they had fined the operator $220,000, and that the fine
could keep growing until the problems are remedied. Specifically, regulators
found that one of the facilities was not following infection control safety
practices and guidance recommended by federal officials during the
pandemic.
PHOTOGRAPH –The
building is owned by Altitude Health Services. Medical workers with a patient
from Andover Subacute and Rehabilitation Center. The building is owned
by Altitude Health Services. Credit...Eduardo Munoz Alvarez/Getty Images
The nursing
home industry is pushing for broad immunity in the wake of the pandemic. So
far, 16 states, including New York, New Jersey, Michigan, Georgia and Illinois,
have already approved measures granting immunity from lawsuits — a
development that worries longtime critics of the industry.
“A lot of these
nursing homes are trying to get immunity because of Covid, and that is
really scary because some of these companies are so negligent,” said Charlene
Harrington, a professor emerita of nursing at the University of California,
San Francisco. Many for-profit nursing home operators report meager profits
only because income is “drained off in their management contracts,” she
said.
Not all nursing
home buyouts have worked well for private equity firms. In 2018, HCR
ManorCare, which was the nation’s second-largest nursing home operator, filed
for bankruptcy protection — a decade after the Carlyle Group, a big private
equity firm, acquired it. When it filed, ManorCare had $7.1 billion in debt,
and its facilities had racked up numerous citations for failure to treat
infections and properly monitor residents’ medications, records show.
Years before
ManorCare declared bankruptcy, Carlyle sold the homes for $6.1 billion to a
real estate investment trust, a move that largely wiped out the debt of the nursing
homes. ManorCare then rented many of those facilities.
Serious
Deficiencies
Nursing homes
flagged as "Special Focus" facilities have persistently
under-performed in government quality metrics. Regulators also flag homes that
have recently been cited for patient abuse. These situations are rare, but are
more common among for-profit entities.
[GO TO WEBSITE
FOR INTERACTIVE CHART OF “SPECIAL FOCUS” AND PATIENT ABUSE CHARGES.]
In November, Senators
Elizabeth Warren of Massachusetts and Sherrod Brown of Ohio sent letters to
four private equity firms, including Carlyle, seeking information about their
involvement with nursing homes. Carlyle, in its response to the two
Democrats, said that patient care had not been affected during the
bankruptcy and that all employees were paid. A spokeswoman for Carlyle,
which no longer owns any nursing homes in the United States, declined to
comment.
A
representative for Ms. Warren said that only Formation Capital, an
Atlanta private equity firm that specializes in nursing home investments,
hadn’t responded.
Formation led
the buyout of Genesis Healthcare, the nation’s largest nursing home
operator, in 2007; Genesis returned to the public markets seven years later.
The private equity firm has a consulting arm that sells services to nursing
homes, including some that Formation owns or has a financial interest in.
Formation has
said in a filing that it had policies “that are intended to mitigate
this potential conflict of interest.” The firm did not respond to requests
for comment.
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The Coronavirus
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WRITERS
Matthew
Goldstein covers Wall Street and white collar crime and housing issues.
@mattgoldstein26
Jessica
Silver-Greenberg is an investigative reporter on the business desk. She was previously
a finance reporter at the Wall Street Journal. @jbsgreenberg • Facebook
Robert Gebeloff
is a reporter specializing in data analysis. He works on in-depth stories where
numbers help augment traditional reporting. @gebeloffnyt
READ 141
COMMENTS
PRIVATE EQUITY
OWNERS*
ALTERNATIVE
INVESTMENTS PRIVATE EQUITY & VENTURE
CAP
Understanding
Private Equity (PE)
By TROY SEGAL
Updated Apr 15,
2020
. . . .
KEY TAKEAWAYS
Private equity
refers to capital investment made into companies that are not publicly
traded.
Most private
equity firms are open to accredited investors or those who are deemed
high-net-worth, and successful private equity managers can earn millions of
dollars a year.
Leveraged
buyouts and venture capital (VC) investments are two key private equity
investment sub-fields.
What Is Private
Equity?
Private equity
is equity—ownership or an interest in an entity—that is not
publicly listed or traded. A source of investment capital, private
equity actually comes from high-net-worth individuals and firms that purchase
shares of private companies or acquire control of public companies with plans
to take them private, eventually delisting them from public stock
exchanges. Most of the private equity industry is made up of large
institutional investors, such as pension funds, and large private equity firms
funded by a group of accredited investors.
Public company
From Wikipedia,
the free encyclopedia
. . . .
A public
company, publicly traded company, publicly held company, publicly listed
company, or public limited company is a company whose ownership is organized
via shares of stock which are intended to be freely traded on a stock exchange
or in over-the-counter markets. A public company can be listed on a stock
exchange (listed company), which facilitates the trade of shares, or not
(unlisted public company). In some jurisdictions, public companies over a
certain size must be listed on an exchange.
**** ****
**** ****
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